Physical exercise therapy may support osteosarcopenia management in elderly patients according to this narrative review

With global population aging accelerating, osteosarcopenia—the coexistence of sarcopenia and osteoporosis—has become a critical health challenge leading to frailty, falls, and disability in the elderly. This syndrome is closely linked to chronic inflammation, metabolic imbalance, and cellular aging. Physical exercise therapy, as a non-pharmacological intervention, shows unique advantages in preventing musculoskeletal degeneration and restoring metabolic homeostasis. Evidence indicates that regular aerobic and resistance exercise promotes osteogenesis and muscle protein synthesis while inhibiting bone and muscle loss through mechanical loading, regulation of myokines and osteokines, and energy metabolism remodeling. Key molecular pathways include activation of the SIRT1/AMPK/PGC-1α axis, modulation of mTOR signaling, and suppression of inflammatory cytokines such as IL-6 and TNF-α, which collectively enhance mitochondrial function and reduce oxidative stress. Moreover, physical exercise strengthens muscle–bone crosstalk via factors like irisin, myostatin, osteocalcin, and sclerostin, exerting systemic anti-aging effects. Future studies should emphasize personalized physical exercise prescriptions combined with biomarker monitoring and smart technologies to achieve sustainable musculoskeletal health and promote healthy aging.